Narrative synthesis of health service accreditation literature

1Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney,
New South Wales, Australia

2Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney,
New South Wales, Australia

Correspondence to
Dr Reece Hinchcliff, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney,
NSW 2052, Australia; r.hinchcliff{at}unsw.edu.au

Accepted 2 September 2012

Published Online First 4 October 2012

Abstract

Aims To systematically identify and synthesise health service accreditation literature.

Methods A systematic identification and narrative synthesis of health service accreditation literature published prior to 2012 were
conducted. The search identified 122 empirical studies that examined either the processes or impacts of accreditation programmes.
Study components were recorded, including: dates of publication; research settings; levels of study evidence and quality using
established rating frameworks; and key results. A content analysis was conducted to determine the frequency of key themes
and subthemes examined in the literature and identify knowledge-gaps requiring research attention.

Results The majority of studies (n=67) were published since 2006, occurred in the USA (n=60) and focused on acute care (n=79). Two
thematic categories, that is, ‘organisational impacts’ and ‘relationship to quality measures’, were addressed 60 or more times
in the literature. ‘Financial impacts’, ‘consumer or patient satisfaction’ and ‘survey and surveyor issues’ were each examined
fewer than 15 times. The literature is limited in terms of the level of evidence and quality of studies, but highlights potential
relationships among accreditation programmes, high quality organisational processes and safe clinical care.

Conclusions Due to the limitations of the literature, it is not prudent to make strong claims about the effectiveness of health service
accreditation. Nonetheless, several critical issues and knowledge-gaps were identified that may help stimulate and inform
discussion among healthcare stakeholders. Ongoing effort is required to build upon the accreditation evidence-base by using
high quality experimental study designs to examine the processes, effectiveness and financial value of accreditation programmes
and their critical components in different healthcare domains.